Present and Future Pharmacist Roles in Medication Abortion Care – Birth Control Pharmacist

Twenty years ago, the FDA approved mifepristone. Since then, medicine has changed the accessibility of abortion. In 2017, approximately 39% of abortions in the United States were medication abortions, reflecting the preference of many people for this option.¹ As reproductive health services change, it is important that pharmacy services be adaptive with them.

What is an abortion drug?

A medical abortion is the use of drugs to end a pregnancy. There are several drug abortion regimens, but the only regimen approved by the FDA is a combination of mifepristone and misoprostol to terminate a pregnancy up to 70 days gestation.²

First, a patient takes 200 mg of mifepristone orally followed by 800 mcg of misoprostol buccally, 24-48 hours after the mifepristone dose. After 7-14 days, the patient should follow-up with a health care provider.²

Mifepristone works by competitively binding to the intracellular progesterone receptor, thus blocking the pregnancy-supporting effects of progesterone.³ Misoprostol works by inducing contractions in the myometrium as well as relaxing the cervix.⁴

According to a systematic review conducted by the American College of Obstetrics and Gynecology (ACOG), medication abortion is 97% effective up to 70 days after conception.⁵

Demonstrate the roles of the pharmacist in medication abortion

Today, the pharmacist’s role in dispensing medications is minimal as patients receive their dose of mifepristone at the clinic to take at that time or at home. A prescription for misoprostol can be filled at a pharmacy to be picked up by the patient. Pharmacists will advise patients on how to take misoprostol and what to expect from this medication.

Mifepristone can only be dispensed in a clinic as a result of restrictions implemented as part of the Risk Evaluation and Mitigation Strategies, or REMS, with an exception allowing mail order during the pandemic. The goal of REMS is to ensure that the benefits of a drug outweigh its risks. Recently, there are safety studies of mifepristone to determine whether REMS requirements are necessary or not.

Future roles of the pharmacist in medication abortion

According to articles published in New England Journal of Medicine and Journal of the American Pharmacists Association, the REMS restrictions on the use of mifepristone were deemed medically unnecessary because the rates of adverse events and mortality were so low. Since its approval, only 19 deaths have been reported to the FDA from over 3 million patients who took mifepristone giving it a mortality rate of 0.00063%.⁶ Additionally, analysis of data from studies of more than 423,000 women, showed that non-fatal serious adverse events from the use of mifepristone ranged from 0.01-0.7% and were almost always treated.⁶

Research studies are underway to evaluate trial-free medication abortion protocols, telehealth services for medication abortion, and pharmacy dispensing of mifepristone. As new information emerges, there will be more opportunities for pharmacists to play a role in medication abortion care.

The educational program for pharmacy students and practical abortion pharmacists is limited. The University of California San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH) recently released a home study continuing pharmacy education program titled “The Role of Pharmacists in Abortion Medicine” which is free and open to all. Birth Control Pharmacists have open access introductory curriculum that can be integrated into pharmacy curricula.

Conclusion

In sum, medication abortion is a critical and common part of women’s health and reproductive health services. Although there are currently restrictions on the ways in which patients can obtain abortion drugs, many of these will soon change and pharmaceuticals will become an important part of access.

This article was originally published on Pharmacy Hours.

SOURCES

1. Jones RK, Witwer E and Jerman J, Abortion Incidence and Service Availability in the United States, 2017, New York: Guttmacher Institute, 2019, Accessed September 8, 2020. https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017
2. US Food and Drug Administration (FDA) information, Mifeprex (mifepristone), 2018. Accessed September 20, 2020. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information
3. Mifeprex (mifepristone) [prescribing information]. New York, NY: Danco Laboratories, LLC; April 2019.
4. Cytotec (misoprostol) [prescribing information]. New York, NY: Pfizer; February 2018.
5. Chen, MJ, Creinin, MD. Mifepristone with buccal misoprostol for medical abortion: A systematic review. Obstetrics and gynecology, 2015;126(1), 12-21. Obtained from https://escholarship.org/uc/item/0v4749ss.
6. Mifeprex REMS Study Group, Sixteen years of overregulation: time to unburden Mifeprex, N Eng J Med, 2017;376(8):790-794,https://www.nejm.org/doi/full/10.1056/NEJMsb1612526.
7. Raifman S, Orlando M, Rafie S, Grossman D. Abortion medication: potential for improved patient access through pharmacies. 2018;58(4):377-81.